1. Florida Politics

On Medicaid? You may soon have to work for it in Florida

Rep. Travis Cummings says the proposal would help the system function better.
Published Apr. 8, 2017

TALLAHASSEE — Medicaid recipients in Florida could soon have to meet work requirements and pay a premium to stay in the government-funded health care program.

The Florida House is moving ahead with a plan to force able-bodied Medicaid recipients to prove they are employed, participating in job training or searching for work to receive benefits, the same requirements the state puts on welfare recipients. The House also wants to require most Medicaid recipients to pay $10 or $15 a month, depending on their income.

Failure to meet the requirements within a 60-day grace period would result in a loss of Medicaid coverage for a year.

It's an effort to encourage people to work and to take their health care more seriously, says Rep. Travis Cummings, R-Orange Park, chairman of the Health and Human Service Committee. He said he has heard from health care providers who complain of patients missing appointments or avoiding preventive care entirely and only using the emergency room.

"Medicaid eats up roughly 30 percent or so of our budget and just keeps rising tremendously," Cummings said. "We just feel that when someone has a little skin in the game, even if it's just 10 bucks a month, that they may take that more seriously, that it can help the system function better and help control cost."

The House's Health and Human Services Committee passed Cummings' proposal 14-2 on Thursday as part of broader legislation making a series of changes to Florida's Medicaid system five years after the state turned it over to private health plans, or so-called "Medicaid managed care."

Florida already has one of the most restrictive Medicaid programs in the nation. It is open only to adults with dependent children, pregnant women, low-income seniors and people with disabilities.

For adults to be eligible, they must make less than $6,652 in annual income for a family of three, according to the Kaiser Family Foundation. In states that have expanded Medicaid, the eligibility limits are close to $30,000 for a family of three. Florida covers children whose parents earn almost $30,000.

About 3.2 million Floridians are enrolled in the Medicaid managed medical assistance program. About half are children, and still more are elderly or disabled, and likely would not be subject to the work requirement.

Some Democrats and progressive activists opposed the bill, saying it would be a burden on the poor and could make it more difficult to escape poverty.

"It's onerous," said Rep. Lori Berman, D-Lantana. "We have these people who are in such dire financial shape."

Karen Woodall, executive director of the Florida Center for Fiscal and Economic Policy and an outspoken advocate for programs such as Medicaid, said that the proposed premiums may sound inexpensive but that they can be cost-prohibitive to low-income families.

"I understand that for many, paying $10 a month or $15 a month for your health care doesn't sound that bad," she told lawmakers. "But (for people making) $500 a month or $1,000 a month, every little bit matters."

The Senate would have to sign on to the work requirements and premiums, and so far it has not.

Additionally, the federal government would have to okay the changes, something it has been reluctant to do in the past. But the new Trump administration has brought in health officials who appear more willing to consider changes like those the Florida House is proposing.

Last month, U.S. Secretary of Health and Human Services Tom Price sent a letter to governors urging them to make changes to Medicaid. More than half of the money in the health care program comes from the federal government, but states get to decide how it is spent — assuming Washington gives its approval.

In the letter, Price recommended "reasonable, enforceable" premiums as a way to prepare Medicaid recipients for commercial health insurance. He also urged states to pursue "innovations that build on the human dignity that comes with training, employment and independence."

One key component of the plan is negotiable, Cummings said: the length of time people could get kicked off the Medicaid program if they don't meet work requirements or pay up.

"Twelve months is pretty darn extreme," he said, acknowledging the number is "arbitrary."

Still, Cummings wants some sort of waiting period. He was not convinced by arguments that removing people from Medicaid could have worse effects long-term. Without coverage, opponents say poor people might forgo less costly preventive care and end up in more expensive emergency rooms when they're really sick. That could rack up costs that hospitals push onto patients with commercial health plans from their employers or Affordable Care Act exchanges.

"We just feel there's some inefficiency there so we wanted to put some teeth in to ensure prompt payment," Cummings said.

Times staff writer Kathleen McGrory contributed to this report. Contact Michael Auslen at Follow @MichaelAuslen.


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